Calearo C, Bignardi L
Acta Otorhinolaryngol Ital. 1989 May-Jun;9(3):281-95.
The authors conclude 18 year's experience with reconstructive laryngectomy by adopting two surgical techniques for intrinsic laryngeal tumors. The first, where one or both of the arytenoids are conserved, can be applied in cases of supraglottic neoplasms extending to the glottis as well as in glottic cancers where a simple cordectomy is not feasible. In both cases this technique is indicated when at least one arytenoid is respected. The second technique involves removal of both arytenoids and is used in cases of intrinsic supraglottic or glottic tumors extended to both arytenoids. The anatomic-pathological criteria supporting these techniques are: 1) the presence of a fibrous ligament anterior to the arytenoid vocal process. This makes possible proper exeresis within healthy tissue (as can be done in supraglottic surgery due to the anatomic characteristics at the anterior commissure level); 2) neoplastic infiltration of the cricoid cartilage takes place exceptionally in supraglottic and glottic neoplasms; in such cases neoplastic manifestation can be radiographically identified. Generally removal of the soft tissues and of the perichondrium within the cricoid area grants conservative surgery the same oncological radicality as that of total laryngectomy. Insights into restoration of laryngeal function when employing the arytenoid-preserving technique are as follows: 1) conservation of the recurrent nerve(s) 2) pulling the base of the tongue back and downward; close to the crico-arytenoid structure can be achieved by crico-hyoid-pexy. In the technique involving removal of the arytenoid: 1) reconstruction of two pseudo-arytenoids 2) the base of the tongue has to be brought close to the edge of the cricoid cartilage possibly by crico-hyoid-pexy. A total of 21 patients have undergone surgery with these techniques since 1984 and to date no neoplastic recurrences have been observed. Those who underwent surgery where the arytenoids were preserved (16 cases) showed laryngeal functional recovery times similar to those for supraglottic surgery. The recovery times were longer for those undergoing bilateral arytenoidectomy (5) and this was especially so for swallowing.
作者总结了采用两种手术技术治疗喉内肿瘤的18年重建喉切除术经验。第一种技术是保留一侧或双侧杓状软骨，可应用于声门上肿瘤累及声门的病例，以及无法进行单纯声带切除术的声门癌病例。在这两种情况下，当至少保留一个杓状软骨时，就可采用该技术。第二种技术是切除双侧杓状软骨，用于声门上或声门内肿瘤累及双侧杓状软骨的病例。支持这些技术的解剖病理学标准如下：1）杓状软骨声带突前方存在纤维韧带。这使得在健康组织内进行适当切除成为可能（由于前联合水平的解剖特征，在声门上手术中可以做到）；2）环状软骨的肿瘤浸润在声门上和声门肿瘤中极为罕见；在这种情况下，肿瘤表现可通过影像学识别。一般来说，切除环状软骨区域内的软组织和软骨膜，可使保守手术具有与全喉切除术相同的肿瘤根治性。采用保留杓状软骨技术时恢复喉功能的见解如下：1）保留喉返神经；2）将舌根向后下方牵拉；通过环甲固定术可使其靠近环杓结构。在涉及切除杓状软骨的技术中：1）重建两个假杓状软骨；2）可能通过环甲固定术使舌根靠近环状软骨边缘。自1984年以来，共有21例患者采用这些技术进行了手术，迄今为止未观察到肿瘤复发。保留杓状软骨的手术患者（16例）的喉功能恢复时间与声门上手术相似。双侧杓状软骨切除术患者（5例）的恢复时间较长，吞咽功能恢复尤其如此。
